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HomeMy WebLinkAbout018-2011-68-000Wisconsin (;epartment of Commerce PRIVATE SEWAGE SYSTEM u~fety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Waldschmidt, Richard Hammond, Town of :ST BM Elev: Insp. BM Elev: BM Description: ~~ ~~''~ ~ GS i t•ANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / ' t 5 Dosing c°~.~~ ~ Holding TANK SETBACK INFORMATION TANK TO P/L Sa WELL BLDG. Vent to Air Intake ROAD Septic / / f ~ ~ / c5 i ___. / Aeration Holding V~ PUMP/SIPHON INFORMATION '/ ~,1; Manufacturer ~ errand o v GPM Model Number ~ ~ ~~ ZS TDH Lift~~• ~ Friction Loss System H~ /~ 3 TDI-L_ • ~Ft Forcemain Lengtt15 • Dia. Z, ~ Dist. to well /~ SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 479274 ~ ~DI ~ State Plan ID No: Parcel Tax No: 018-2011-68-000 Section/Town/Range/Map No: 30.29.17.1083 STATION BS HI FS ELEV. Benchmark ~' ~ /~~~ Alt. BM Pv `,~ I $` ` Bldg. Sewer ~Z • ~~ ~~ l ~~p SUHt Inlet I Z ~ `fs ~ J, b S St/Ht Outlet ~~ Dt Inlet ~_ Dt Bottom ~(o• ~ ~' Header/Man. ID.(>o s3 .75 Dist. Pipe /0. t,5 il. I $ 93.75 •Z $ Bot. System Final Grade ~ .' ~ S• 3 St Cover J ~r O ~~ ~ S -r•~ 11.1 ~rZ•~ BED/TRENCH Width Length ~ No. Of Trenches PIT DIMENSIONS No. Of Pits` Inside Dia. Liquid Depth DIMENSIONS 3 $~ d.. 5~, Z ~~C~.G ~ ~~ ` SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: (~ ~ (, ORM TION CHAMBER OR 'raF~ 1.n.d'~ INF A Type Of System: ~ ~~ i ~r ^' f ^ A / ,/~ UNIT .., , r Model Number. j~ J ~ DISTRIBUTION SYSTEM Z~~-7~7 ll,.Q,r~~\ Header/Manifold ~~ Distribution x Hole Size x Hole Spacing Ve t to Air Intake ~ ~ ~ ~ Pipe(s) ` \ i ~ S i \ ` e1 '~ f Dia Length pac ng Length D a Sall Cn~/1=t~ v D~nem mn Qvc}nmc Anh, vv Mnunrl nr' Ot'.h1'AftP SVCtPmS Or1IV ~~~.Orw+~--~ Depth Over i Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Centel Z • ~ "C.~ N Bedrrrench Edges Topsoil ~ ~ _ Yes - No i _ Yes ~; ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /, Location: 787 157th Stre Hammond, WI 54015 (NW 1/4 NE 1/4 30 T29N R17W) Emler~al~d ALcres 1st Add Lot 68 Parcel No: 30.29.17.1083 1.) Alt BM Description = ~~~ ~~~`' ~"^'~^'~ ~ ""'"""'S 2.) Bldg sewer length = Zc} So•~t S ~ •~ f~~~~-- V O ~~'~"' ~~ - amount of cover = ~ I r/ Plan revision Required? Yes ~~ No ~ + ~~ L Use other side for additional in ormation. ~ ____~ _L-~ Date SBD-6710 (R.3/97) v~ I ~~3 Y 5 ~- - ~ Cert. No. W,, Washi gton Ave., P.II~I: iscansin p,~ i WI~~ jj~a07 - 7162 De artment of Commerce 608)2b5P s . Sanitary Permit Ap atiRO, In accord with Comm 83.21, Wis. Adm. Code, personal infortna a may be used for secondary Purposes Privacy Law, s 15. t14(1)(m FICA I. Application Information -Please Print All Information Properizlt C~,vner~ Name ~ 1 ~ ~ - n Property Owner's Mailing r by c .. State Plan I.D. (if different than mailing addiess) /S7 ~ S~` Lot # Block # P,,r//o~~p~~ert~~y Location y~. ~~ ' ~, Section ~ Q ~circle~yj II. T e of Buildin T N; R E yp g (check all that apply) ~ fj~brnr a ~1 or 2 Family Dwelling - Number of Bedrooms _ ~ ubdivi ion N CSM Number ^ Public/Commereial -Describe Use ~~ ^ State Owned -Describe Use ^City VillageJ~1'ownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System B• ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer to New Lrst ~OO~ Permit Number and Date Issued Before Expiration pl~~ ~~ IV. T e of POWTS S stem: Check all that a I ' on -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Psss Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Leaching Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. Dis ersaVTreatment Area Information: Design Flow (gpd) Design So~Application Rate(gpdsf) Dispersal Area Required (sfj Dispersal Area Proposed (sf) System Elev~p~ 0 7 J~e-7 '~ ~ = YOf f~' VI. Tank Info Capacity in Total Number •~----~-~ --- Gallons Gallons of Units New Fvtisting Tanks Tanks Septic or Holding Tank Aerobic Tn;atrnent Unit Dosing Chamber 0 ..~ ©O VII. Responsibility Statement- I, the undersigned, assume re (Street, City, state, zip Prefab Si Steel Fiber Plastic Contxete Constructed Glass for i Ilation of the POWTS show~on the attached plans. RS Number Business Phone Number ao.3s~ ~ ~~s a~$ VIII nun /De artment Use Onl Approved ^ D' roved Sanitary Permit Fee (includes Ground Date Issued Issuing t Si Surcharge Fee) ^ er n Reason ial ~ ~ z 1X Conditions of ApprovaUReasons for Disapproval ~. ' twtk, .plubtt tAtsr and ~"~"^~ dispersal till mtmt all be services / maintaine,~ as per management plan provided by plumber. 3. AN seflaaek requirements must be maintained a!s per spplcable code /ordinances. Attach complete plant (to the County only) for the rystem ou paper not las than 51/Z x 11 lochs to aua SBD-6398 (R. 01/03) ~GOULDS PUMPS Submersible Effluent Pump EP04 & EP05 Series APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/a"maximum. • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- . rota ry/ceramic-stat I o n a ry, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140°F (60°C) intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic semi-open design with pump out vanes for mechanical seal protection. METERS FEET 10 9 3 a z o ~ a W x u 6 2 z 5 o t a a 0 ~ 3 1 z 1 0 ^EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SA, Canadian Standards Association File # 1R38549 Goulds Pumps is ISO 9001 Registered. Motor: •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 1550 RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SlTW with three prong grounding plug. Optional 20 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). © 2003 Goulds Pumps Effective July, 2003 B3871 0 2 4 6 8 10 12 m3/h caPacrTV ,r ~'Gou ds Pumps ~a ,L1,. ITT Industries ~0 10 20 30 40 ~ 50 GPM COMBINATION SEPTIC/DOSE CHAMBER TANK & PUMP SPECIFICATIONS PER COMM 84.25 CODE CHANGES 2/1/2004 Access Opening, nat top of cover, must adend to a point no greater than 6" Below Finished Grade Cover with ~G~l?Fa Locking Device ~ A (typical) ~UII.i~NVFt• ~ if 'EVV ~1~ ~ ~ ~ . o~ INSULT Min. Z3" Access Opening pF~ Ouha Effluent Filter ~ Inlet Baffle Access Opening, not top of cover, must e~end at least 4" Abave Finished ~yade . ~'v ~ `/ ~i Y~~ ~ ~~ Finished Grade I l2 x ,.-- Min. 23" Access Opening ~!'l ./~'I iN./mar vm ~ 2 "~G ,~,r?C~/hl~~/V ~ ru~~ if ~'p/c S!~'~ .~ .Union A.~go,2oV~A ~/P~ 3 PT, ~~p~ p/t/`TD .SOL/D SOIL 3 "Sand ar g rtt ~- ~ ~n~yunal a f- w i ~ L'~~'I-,~r 2 •• /per Shan pilyp-r ComparFment SepticJPumpTank ~,~ ~ /,t/e~q~ oil Ovfside GUaI~ SPECIFICATIONS TANK MFR: TANK SIZE: ALARM MFR: MODEL # Switch type: SEPTIC DO GAL. DOSE ~_ GAL, PUMP MFR: MODEL #: SWITCH TYPE: B = _2_INCHES = -~7~-GAL. C = INCHES = _~~GAL. REQUIRED DISCHARGE RATE ~~ GPM PUMP & ALARM WIRING PER COMM 83.43(8)(e) VERTICAL DIFFERENCE BETWEEN PUMP OFF & DISTRIBUTION PIPE (LIFT) _ ~ ,3~T. MINIMUM NETWORK SUPPLY PR S E (DISTAL & NETWORK PRESSURE) _ + ~- FT. ~FT. OF FORCEMAIN x ~ FT./100 FT. FRICTION FACTOR ...... _ + F~. INTERNAL TANK DIMEN~ MP/MPRS SIGNATURE: TOTAL DYNAMIC HEAD (TDH) _ ~ FT. LIQUID DEPTH DOSES PER DAY: ClJOCJ DOSE VOLUME: GAL. (INCLUDES FLOWBACK &~<20% OF DWF) CAPACITIES: A = ~~"'~-I'NCHES = _~~GAL. NUMBER: - ~~ ~~ y-~. N~ cu~-~ /{-/DO Zo-Fi-Q. ysq y ~ ~~~ D~ • ~ ~3 ~ x ~a / ~ r~aao 3s~ ~I ~~ 1 Nyo~ ~.~-~s a ~ 5y ~~ /\ ® ~ Safety and Buildings ivisio ,{~- 201 W. Washington Ave., .0. Box~"7',~'" County ,~ ~ ~` ~. ~ (,~(1- ' ~-' ~ ~~~~~~~ Madison, WI 537 7 - 7162 '~* ~~ ,~S it Number to be filled in b Co.) (608) 266- 151 ~/{ _ ; , `~ ` ~~ 2 Department of Commerce l r Sanitary Permit Applieatio " s C/ ' ,.state Planl .Number -~ ~''~r i . ~ . In accord with Comm 83.21, Wis. Adm. Code, personal information yo ~ / ;.7 ~/' ~ may be used for secondary purposes Privacy Law, s15.04(1)(m) >P~roject dress (if different than mailing address) 1. Application Information -Please Print All Information 1 ~ ~ ~. ~ T / / l Prope Owner's ame ~ Lot # Block # Parcel # S Prop y Owner's Mailing Ad~rass Property ocation ~ ~/./J(J r Section ~ ~~ '/a ~~4 City, State Zip Code Phone Number ~ , , // ` W ircle one) T~N; R~E or W ~~ '"" lI. Type of Building (check all that apply) ~ E9fe1-1~ffRl7~r ~I or 2 Family Dwelling-Number of Bedrooms ~~.~ u vision am ^ Public/Commercial -Describe Use ^ State Owned -Describe Use ^City_ V'llage ownship of IfI. Type of Permit: (Check only one box on line A. Co late line B if applic (e) Q 8-LO//- (o ' Ua . f A' New System " ^ Replacement System ^ Treatme Holding Tan eplacement Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. T e of POWTS S stem: Check all that a 1 tt,t Z Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding T ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirc ating Sand Filter ^ Recirculating Synthetic Media Filter Leaching Chamber Drip Line ^ Gravel- ss Pipe ^ Other (explain) V. 1)is ersal/Treatment Area Information: e~f.r~T ~-a- Design Flow (gpd) Design Soil A lication Rate(gpdst) ispersal Area Required (st) Dispersal Area Propo System evauon y f ~~C~ ..~~ ~~• ~~ _ . -s o Vl. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel fiber Plastic Gallons Gallons of Units (jg7.~p /~-(60 Concrete Constructed Glass New Existing ~ l Tanks Tanks Septic or Holding Tank Q •+~ 1 Q( Aeaobic "treatment Unit Dosing Chamber VII. Responsibility Statement- I, the dersigned, assume responsibili for i allation of the POWTS sho non the attached plans. Plumber's ame Print) umbe 's MPRS Number Business Phone Number Plumber's Address (Street, City, tate, Zip C e) ~~ VIII. Count /De ai4ment Use Onl ® Approved ^ lsap Sanitary Permit Fee (includes Ground ter Date Issued Issuin Agent Signature (No Stamps) Surcharge Fee) ^ er van Reason for Denial Z~ IX. Conditions pprova val < SYSTEM OWNER: , 1 Septic tank, effluent filter and 1~ S~ . '~.~ Se.~-QS b~t !~i S! -~`S S ~ ~ v . - - ` dis ersal cell must all be serviced /maintained ~ P ~"" V Q P ~ ~` ' ~~ ~ r _s~ ~ 1. ,~~ -~c9 - ~ ~ as per management plan-provided by plumber. u ~Y ~ 2. All setback requirements must be maintained ~,,,,~ y~rt U~ (,j ~ ,~ ~~~ ~ ~ ~~ ~ ~O° ~ ~ e~w'rslrl as per applicable code/ordinances. 5~ a t~rmen compie~e puns lm use i.uumy amyl wr sue syn~c~~~~p..p~..~... ...~~ ....... ..............._..... ....._ - s . ~ l/_l~re_r_~~'{/`/~''(_ O1/\S f7/L/1C~/' ~ t ' ~,y,~ SBD-6398 (R. O 1 /03) w,,ocQ ~ r,`(~s~e,,,-,~ s; ~ ; ~ ~.~Q, ~~,,,~~~ -1~,~ ~{ ~ ~ ~~~ N ~-_!~o ~s ~ y l- ~~ ~ ~ - a ~- ®~ - ~ =~v~ ----- ~\ ~r l~ ~ aa03s~ r`( 1 r=yd ~~-~s T-~-~ coP~ ~ .~ C~.~. ~`3 , ~ nrR ~~~/8rZ , r ~ i'~v x{105; 83 ~ ,a o r'~ o \ ~~ r ~'~~II J S ~~-~ ~~ ~--a = ~~~~-o ~-~ - ~a -/~~ N~~ /~ -~~~ ~ ys ~ y ~-a3~ ~~ i-aa m - / .Sao ~3M~~" gD•ic ~'\ //~ ~Gj ,~~035~ r-~ ~. ya l! r ~~-~~8 T~ ~ ~ re C~ ~ ~3 , ~ ntR ~~~/8iZ ,~'Ior~ ~ ~~U L \ryy`'~ ~ /fv~ ~~~; g3 ~ ,~. ,~ o ~~`'~ ~~ . ., ~ 3'~ T-j ~ x ~ f s -~G-~ ~~ ~ = o~ = ~~~~v ~ t yYi~cortsinDepartrnenloiCommerce SOIL EVALUATION REPORT Payo_ ~ of -3 Ulvis'an ol~afety and Bufld'nrgs in accordarrca wiUr Comm 45, Wis. Adrn. Cvde .. ~----~ courny . C Alladr complete site plan on paper ,rot less Umn 0 nurst __ `< O 1 X inducts, h Ifmiled to: vertlpl anJ horizontal rence~~ U114r6NrMand Parcel LD. D ) / p percent r ~ al~;pr dinnmensions, norOr arrow, an IopUdri anJ distance to nearest r ad. Q~6 'oC D ) ~ ~[~ a- ~ (f'I rlnt all !-rfor ra[!or Qty. R revved Uaie Pmeonel krfomretlon d~ e used for seconder purpos~~rivacy Lnw, e. 15.04 (I) im ~~ / PropertyOwrrer ST.CROIX ~ tyLoc lbn QIC~~~ ~~ ZONING ~ I N ~ 111 N~ 114 5 3D "T 2°i N R ~'~t E (or~V Properly Owners Mailing Add1rness I 1 Lot # Bkx:k # Sulnl. Name urC/Stii# 3 1'`W Ol`>~-\CC~.~~ • ~ l~ _ _ 1`' re __ I T__ I'~G'~ ~ i i DN- C' Sla6e IJ Cudo Plrune Nrinrber --ice -~~ rly p ^ City ^ Villaye ~ f own Nearest Ruad W ( DI tp (l 5 -CQ ~ ~ lry~~l. ~ C'-i-y . P-cl _ ~ T [Jew Construction Use: Residential / Number of bedrounrs _~ ~ Code derived desiyn (low rate _ ~~_ _~o ~~ ___ GPU ^ Replacement ^ Public or commereial - Describe: _-__. --- ' Parent materiel _ ct_~11-_------_- Ruud Piain elevation it applicabieQ_____)/v _/a"' -- _--____ R. General corrnnents ` / ~''?~ ~ O U ~ ~ 6 Z ~~ ~ar~~.o`•~ s F`G~ - - -- arrd recommendations: ~Y ~P~ ~ 11 I ~f~ ~ ~ ~r Gta- ~/u.c~l~ G~d~ ~-ec--- ~~ ~ ~~~ ~~ r ~~~,~r,.~~ ~ <-J Boring # ^ Bcriny pn -- - Pit GruunJ sw(ace elev. _ 1 `7. ~ (L UepUr lu Ihniliny (aclvr _ ~(,, rn. _ _ ~`--- _ Sol A licalion Rate Horizon UepUr Uorninanl Color Redox Uescriplion Texture Sbuclure Consistence F3uuntlary Rarl , GP UIIt' in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. - 'EfF#1 _ 'Elf#2 I Z p~t2 12.2 -~-~- t U - `- Sr,.1 si ~ 1 Zm-~~ 2m5bk ~ ~ - ~ S - ~_ ~ ~-~' -" 5 - `{ .8 - ~ 3 $9 ~ 4~ `i s Cis ml - `" -~ 1.2 r ~~ 7~ ° - - ---- Boring # ~ Bonny Plt Ground surface elev. ~ ~_?~ Ft. Depth tU limiting factor _~ in. Sol Application Rate Horizon DepUr Uorninant Color Redox Description Texture Slruduie Consistence Boundary Fiuols GPD!(F in. Munseli Qu. Sz. Cont. Cobr Gr. Sz. Sh. _ 'EFF#1 'ER#2 I p-tQ Z, ~- Si r' ZmS YYI~r^ _~_ ~ v-~_ 5 . 8 3 2[p -99 s -~- _ m l - - . ~ 1.2 ~.~ - - -- - -- -- - ~~ ~ ;~ 2 7 - - Eliluent Mt = BODs > 30 < 220 nrg/L aril TSS >30 < 1 r0 my/L ' ERluent #2 = BOD< < 30 rny/L and TSS < 30 mg/L CST Name (Please Print) nature CST Nwnber Address Date Evaluation Conducted Telepttune Number ~ ~ 3 ~~- ~ . ~m~ w ~ ~0~ ----_ - - -----~_~~ ~~ 7~d -029 _ Parcel ID tt _ / - Page --~ of ~ 1 Property Owner ~~~----- ~G i~ ~~ --------- U Boring I --~~ Boring # ~" Pit Grou ~ qlp nd surface elev. tt . U e epUr tv dnaiting ( durv Sl actor --irr• Consistence Boundary oots _ Sod n icaUm7 Rite PD~' limizon DepUr in. Dominant Color Mansell RedoxDesc,~iplion Qu. Sz. Crnrt Cobr Textur ru Gr. Sz. Sh. 'EfI11G Ettg2 3 c.i3~ `~ D 4~4 --~ S ~~c. _ rr 1- - - - =- - ~ _I . _2 LJ Boring Boring # - ^ Pit :Ground swiar;e elev. ~ tt. Depth to limiliny factor ____ irr• Soo A IicaUon Rate Florizma DepUr in. Dominant Ctrkx Munsell Redox Description Qu. Wiz. Cont. Cobr Texlure SUudurv Gr. Sz. Sh. Consislerrce Boundary Roots GPDIIf 'E1t#1 'E(TN7 U Boring Boring # Ground surface elev. _-__- ft. Depth to limiliny tacbr ____.__.____ in. __ ^ Pit _ Sod /1pplicaUon Rale b Texlure SUudurv Consistence Boundary Rrwts GPDIfF Horizon DepUr in. Dominant Color Munsell n Redox Despipt Qu. Sz. Cont. Cobr Gr. Sz Sh. 'Eff#1 'Eff#2 'Effluent #1 = BODS> 30 < 220 mglL and TSS >3U < 150 mylL ' EUluent if2 =BUDS < 30 mylL and TSS < 30 nry/L "fhe llepatitnent of Commerce is an equal opportunity service provider and employer. tf you ncod assistance to access services or need n-aterial in art altetnatc fomtat, please contact the depatUncnt nt G08-2G6-3151 or '1'1'Y G08-2G4-8'177. SRD-N301R.07IOII) 1'Ac;L'~oP~ .~ NAIv1[:: ~ GJ'4" LOI";l_~Q~---1,1:(;;'.l.l)I:SI_'Itll''I'11j11:1rw~ I/~1,~_~y,li,l,;~p_1'Zq,Tl,lt,l~_L:(ur~ -- --- ~ -- SCALE: 1"= Ll U __. --------------- - _------ - _ _ _. __ ~ ~1: (~ l- -. 't" - Dh[ t DGSCRII' I~IOI L _-~U o~ ~_~Q~~_.-t ~p~_ __ -- I I3M 2 I~LI:V~\'I I~ ~I J: _ ~~. ~ _ _ ~ Sec~36_..---- ---------- [3M 2 DGSCI(11'I"Ic)Id: __fiaQ a~-i `Q`IG--Q.~-P~-- -- ,; _q~,, ~o SYS"1'lavl L•I.1?V~1 l li ~I1 SYS"I'I~1~1 "I"ti'l'l.:----C~p.SL-en~U/~cr`~ .- --ob--- ___ _._ -- - - -- -- s ~._ (pS o° .. ~~~ ~a ti to° ~~ ~` g~i lvi-a [ ~` c~'~. I 2 ~' ,: ~ - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2 FILE INFORM ION Owner Permit # ~~. 2 ~ DESIGN PARAMETERS Number of Bedrooms ^ NA Number of Public Facility Units ~'- ^ NA Estimated flow (average) ~d al/day Design flow Ipeakl, (Estimated x 1.5) ~yQ~ al/day Soil Application Rate ~ al/day/ft2 Standard Influent/Effluent Quality Monthly average * Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ^ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODE) <_30 mg/L Total Suspended Solids (TSS) <_30 mg/L ^ NA Fecal Coliform (geometric mean) <_104 cfu/100m1 Maximum Effluent Particle Size YS in dia. ^ NA Other: ^ NA *Values typical for domestic wastewater and septic tank effluent. eenrurcuniurc cr•ucnr~i c SYSTEM SPECIFICATIONS Septic Tank Capacity ~~ o al ^ NA Septic Tank Manufacturer ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model - a (~ ^ NA Pump Tank Capacity al A Pump Tank Manufacturer A Pump Manufacturer ~,NA Pump Model ~ Qg NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~.NA Dispersal Cellls) ~In-Ground (gravity) ^ At-Grade ^ Drip-Line ^ NA ^ In-Ground (pressurized) ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: ^ NA Service Event Service Frequency Inspect condition of tankls) At least once every: ^ monthls) (Maximum 3 years) earls) ^ NA Pump out contents of tankls) When combined sludge and scum equals one-third IY31 of tank volume ^ NA Inspect dispersal cell(s) At least once every: ^monthls) (Maximum 3 years) year(s) ^ NA Clean effluent filter At least once every: ^monthls) ~ yearls) ^ NA Inspect pump, pump controls & alarm At least once every: ^ monthls) ^yearls) NA Flush laterals and ressure test P At least once eve rY~ ~ ^monthls) ^yearls) ~NA Other: At least once every: ^monthls) ^yearls) NA Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tankls) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third IY31 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page Z of 2 START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankls) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal celllsl. If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellls) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain Isump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shalt be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant replacement system: (~ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T alua ' g ~~ e ai e '~ T1'i~ ~oR- N~b/ L'ONS'?7e(I~TLD~lank be RD1-l18 ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~ G- , Phone ~ .- POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Phone Name s-fa , G ( ('j(/~ 2D~l~ Phone ~/S- 30 (p- (0 (~ This document was drafted in compliance with chapter Comm 83.22(2)Ib11111d1&(fl and 83.54(1-, I21 & 131, Wisconsin Administrative Code. Jun 13.05 06:33p 2~1-a~r~b ST CR017C COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP C;sRTIFICAT[ON FORM p.1 Owr1erBuyer 1~.-GhC~rd ~va(d s~hm i d f Mailing Address ~ ~~ ~XOOI~-W (?OG~ ~!' (-~ Ud SO 4'1 w 0 5 X01 (o Property Address ~~ -gym r [~~u-~s ~8 7 /~ 7 ~~,C, (Verification required from, Planning Department for new CitylState LEGAL DESCRIPTION Parcel Identification Number C~1~_,~ ~ ! ! - ~p~' ~C)~ (. ~0~'3) Property Location ~ '/,, ~ ~/,, Sec. ~ T~N-~ Town of Subdivision Certified Survey Map # ~~ ~4~-rid . ,, Lot # .1'.~~. Volume ~~ .Page # Warranty Deed # ~~~ ~ Volume ~~~~, Page # bS Spec house ^ yes ~no Lot tines identifiablf~ yes O no SYSTEM MAINTENANCE Improper use sad maintenance of yaar septic system could resalt is its premature •failare to handle wastes. Proper mainte~nce consists of ~n,m_nino out the septic tank every flax years or sooner, if needed by a ficca.9Cd pamper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. 'Iht ProPertY•~owner agrees to suhaut bo St. Croix Zoning Department a certification form, sigaod by the owner and by a mastcrplumbcr, joumeymaaphmiber, restrictedplumber or a liceasedpumperverifyingthat (1) the on-site vvasbewaterdisposal system is is Proper operating condition and/or (2) after inspection sad pumping (if accessary), the septic tank is less than 1/3 fall of sludge. I/wc, the undersigned have read the above regrrircmeats and agree to maintain the private sewage disposal system with tht standards set forth, herein, as set by the Department of Commecoe and the Departnseat of NatucaI Resources, State of Wisconsin Certification stating that your septic system has been maintained must be completed and retained to the St. Croix County Zoning Office within 30 days the three c iratioa date. SI CANT / ! P DATE OWNER CERTIFICATION I (we) certify that all statcznents oa this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the erty,descrifiod a~ve,_by virtue of a warranty deed recorded in Register of Deeds Office. _._. ~ ~. 5I A OF LICANT DATE «««*** Aay inforraatioa that is mis-representedrnay result is the sanitary permit being revoked by the Zoning Department. **•**' «` IRCiude with this application: a stamped warranty decd from the Register of Deeds offce a Dopy of the certified survey map if reference is made in the warranty decd l` U Z$16P 051 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Kernon J. Bast and Kernon J. Bast as Attorney-in-Fact for Richard O. Stout, Grantor, and Richard L. Waldschmidt, a married person, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 6 Emerald Acres ls` Addition, St. Croix County, Wisconsin. Recording Area 79t68~8 HATHLEEM H. IiALSH REGISTER OF DEEDS ST. CROIX CO.. MI RECEIVED FOR RECORD 06/0b/2005 03:15PM MARRAMTY DEED EXEIfiT li REC FEE: 11.00 TRAMS FEE: 179.70 COPY FEE: CC FEE: PAGES: 1 Name and Return Address: Edina Realty Title, Inc. 400 S. 2nd St. -Suite 1 I S Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights-of--way of record, if any. 470235 018-2011-68-000 Parcel Identification Number (PIN) This is not homestead property. AUTHENTICATION Signature(s) eC~ BroWn authenticated this 3rd day of Jttne, O~ W ~SC~ Sta e TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats,) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Signatures may be authenticated or acknowledged. Both are not necessary) "Names oFpersons signing in any capacity must be typed or printed below their signature . ~ f"" ernon J. Bat s Attorney-in-Fact for Richard O. Stout ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. P sonally came before me this ~ ~ day of n _~ the above named Kernon J. Bast and Kernon J. Bast as Attorney-in-Fact for Richard O. Stout to me Irnown to be the persons} who executed the forego' instrument and aclrnowledged the same. *Cheri Brown Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 7/20/2005 ) WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 Dated this 3rd day of June, 2005. ac z o ~ o z ~ ~ "'g cs = WW Z 9 O Z = p =z= a W a ~~ J ~ Z ~ ~ C = w a O O ~m ~'~ ~ V g Z Q~ ~ v a a ~ ~ ~z ° ~ u~5 ~ w > p O OC p O W w Q ~ CO O O ~ oc O °-~ 0 ~ 0= ac Ta x ~ o J w4 zw ~ o p0 W,O-„ vvi ~ m O d a ~ 5 N ~~ J W ¢a O 3 p ~ ~ r P7 N~ I 0 - - . i 0 Ir ~ ~ ~ ~ :J in I j ~ II 2Q L -- ~ O R1 J I ~~ i ~u i ~~ w ~ ,Z8'LZ 4 35E - - -~-- _0 F- ('~ y~-n m Uyo ~ ~" Q c II 0 m ('7 _ J I~ ~0 O '-~ 1~ PU ~ J °~ ~a a °~oa °~` ~o~ 4/l3N 3H1 ~O ~+'8 ~~+i ~ ~~'{Y~'~~ Lo~N b/lMN 3H1 ~O 3NIl 1S`d3 ~L4'L££ & l'4L L °, 1N3W3S'd3 3~dNI'd2JQ ~ - - - - _ --------- ~SE'9LZl I- H W ~ Qy ~ ~ o~ (U m m F- L~ ~~ °~ H H O~ 0 (U Z9 H fn ti ~ ay H ~ 0 J o~ (1l m F-- N W U f~/! F Q d O mN '-' tU r (/1 I,L W aN O J N ~` A 0~ w 'v 1% ... 3~ N ~ l~ ~~ N ` .• ~ O cv ~~ 1111 ~2a°~ ~,~, y; •~ / ~ti~~ ~ ~~~ ~ ~ ~ ~~p,G ~~~ ~ o _ . ~ ' ~~~ _ -.108 ,~, ' ~ ~ N C~1 ~ ~ L94 i ~ ~ •, ~~ ~ ~c ~ ~ ~ ~ s`~ ~~~ ` s~ 3~ z / _~ , fit. Croix County Map Output Page Page 1 of 1 °; ~~ ~~z 1083 1084 s~ 108 . ~;~~. ti St. Croix County Planning Department 1101 Carmichael Road Hudson, WI 54016 Phone: (715) 386-4674 DISCLAIMER :The information contained on this map is advisory. Map accuracy is limited by the quality of the public records from which it was xepared. It is not intended as a substitute for an accurate field survey. ERIAL PHOTOS :Aerial photography is date-sensitive. Features that exist ~esently in the County may not be present in the photos. 68 .~ ^ ~o Legend Rft+lltlPa Baarwlaks ~6dluiKloRr ~~= Gcr~ye d ~/w~Y Maps LJ Par GIs P and Pa^noad Q'al n3 gle Streams Dam PerreNal beam Inkrmllknl ~r+eam ...:,3R. U1bkr 72.21.230.178/servlet/com.esri. esrimap.Esrimap?ServiceName=StCroixOV&Client... 6/27/2005